Trading places

Could marijuana replace opioids for pain?

More than 165,000 people died between 1999 and 2014 from an opiate overdose in the United States. Tim McGraw likes to point out that the number of people who died from marijuana overdose during that span was zero.

“Everything under my kitchen sink is more dangerous than cannabis,” McGraw jokes.

McGraw, who lives in Homer Glen, Illinois, founded Revolution Cannabis, a medical cannabis cultivation company near Peoria, and he has been watching with anticipation as marijuana and opioids seemingly switch places. Acceptance of marijuana is growing because of its medical potential, but addictive opioid pain killers are falling out of favor in the medical world. These separate but related developments raise the question of whether marijuana will someday replace opioids as the default medicine for chronic pain.

While marijuana remains illegal at the federal level, Illinois is one of 24 states with a medical cannabis program. Another 15 states allow medical use of cannabis oil, an extract of the marijuana plant. Research shows marijuana can relieve pain by acting on the central nervous system – similarly to opioids – and by causing white blood cells to slow their release of inflammatory molecules like histamine. Marijuana has other medical benefits, such as relief of anxiety and nausea.

Although Illinois doesn’t list chronic pain among the approved debilitating conditions for its medical cannabis program, McGraw says a survey of Illinois patients showed 90 percent of people who have used cannabis for an approved condition like cancer found that it helps with pain. He notes that a court recently ordered Illinois to add chronic post-operative pain to the list of approved conditions, and an appellate court last week denied the state’s request for an appeal. While chronic post-operative pain doesn’t cover all chronic pain, McGraw says it’s a step in the right direction. There are several more lawsuits pending on other conditions, he says.

At the same time, the tide is turning against opioids. Drug overdose deaths set a record in 2014, according to the Centers for Disease Control, and three out of five drug overdose deaths involved an opioid. The National Institute on Drug Abuse says that in surveys of young heroin addicts, nearly half said they began abusing prescription opioids first.

“Some individuals reported switching to heroin because it is cheaper and easier to obtain than prescription opioids,” NIDA said. Consequently, the CDC says the use of heroin is increasing in the U.S. among men and women, most age groups, and all income levels.

The federal Drug Enforcement Agency moved earlier this month to lower by 25 percent the amount of prescription opioids that drug manufacturers can produce next year. Meanwhile, the DEA loosened rules governing medical research on marijuana earlier this year, although the agency declined to remove marijuana from the same “Schedule I” regulatory category as LSD and heroin.

Robert Hunt, president of Florida-based cannabis research firm Teewinot Life Sciences, says the DEA’s move to loosen research restrictions on marijuana will lead to rigorous clinical trials and eventual acceptance of cannabis in the medical field. Hunt says doctors aren’t necessarily against cannabis now, but the cannabis industry lacks consistency with regard to doses and applications. In the next three years, Hunt says, clinical trials will likely establish how much and which type of cannabis to use for a given condition.

Hunt notes that the U.S. Food and Drug Administration likely won’t approve cannabis as a prescription drug until it’s removed from Schedule I status. However, he says that point may become moot as researchers develop synthetic cannabis compounds produced by yeast instead of derived from marijuana plants.

John Ryan, director of Kentucky-based cannabis oil producer United Life Science, says acceptance of medical cannabis is likely to grow because of the ongoing research and the fact that patients no longer need to smoke marijuana to get its effects. There are pills, ointments and a variety of other applications containing cannabis oil, he says, and many don’t even have the psychoactive property associated with smoking marijuana.

As for cannabis someday replacing opioids, Ryan says it will be “slow and sure,” with cannabis likely gaining wide adoption first as a supplement to more traditional pain management methods for conditions like arthritis.

Hunt says the upcoming election on Nov. 8 could be a “watershed,” because several states will be voting on whether to allow use of medical cannabis. He says that could result in 65 percent of the U.S. population having access to medical cannabis.

No marijuana deaths?According to the National Cancer Institute, part of the government-run National Institutes for Health, “lethal overdoses from cannabis and cannabinoids do not occur.” That’s because the cells which respond to marijuana aren’t located in the area of the brain which control respiration, unlike opioids. NCI notes that cannabis can have certain negative effects like rapid heartbeat and slowed movement of food through the digestive tract, but its addictive potential is “considerably lower than that of other prescribed agents or substances of abuse.”